What is the treatment for cellulitis of the ear?

From the Guidelines

Cellulitis of the ear should be treated with antibiotics active against streptococci, such as penicillin, amoxicillin, amoxicillin-clavulanate, dicloxacillin, cephalexin, or clindamycin, for a duration of 5 days, which can be extended if the infection has not improved within this time period 1.

Key Considerations

• The choice of antibiotic should be based on the severity of the infection and the presence of systemic symptoms, with oral antibiotics suitable for mild to moderate cases and intravenous antibiotics reserved for severe cases or those with systemic symptoms like fever.
• It is essential to keep the affected area clean and dry, apply warm compresses for 15-20 minutes several times daily to improve circulation and reduce pain, and take over-the-counter pain relievers like acetaminophen or ibuprofen as needed.
• Patients should seek immediate medical attention if they develop high fever, increasing redness, swelling that spreads rapidly, or if symptoms worsen despite antibiotics.

Causes and Risk Factors

• Ear cellulitis occurs when bacteria, commonly Staphylococcus aureus or Streptococcus species, enter through breaks in the skin from trauma, insect bites, or ear piercings.
• Without proper treatment, the infection can spread to surrounding tissues or even enter the bloodstream, causing more serious complications.

Treatment and Prevention

• Elevation of the affected area and treatment of predisposing factors, such as edema or underlying cutaneous disorders, are recommended 1.
• In some cases, cutaneous inflammation and systemic features may worsen after initiating therapy, probably because sudden destruction of the pathogens releases potent enzymes that increase local inflammation.
• Measures to reduce recurrences of cellulitis include treating interdigital maceration, keeping the skin well hydrated with emollients to avoid dryness and cracking, and reducing any underlying edema by such methods as elevation of the extremity, compressive stockings or pneumatic pressure pumps, and, if appropriate, diuretic therapy 1.

From the FDA Drug Label

Skin and skin structure infections caused by Staphylococcus aureus and/or Streptococcus pyogenes The answer is: Cephalexin (PO) is indicated for the treatment of skin and skin structure infections, which may include cellulitis of the ear, when caused by susceptible strains of Staphylococcus aureus and/or Streptococcus pyogenes 2.

• Key points:
  • Cephalexin is effective against Staphylococcus aureus and Streptococcus pyogenes
  • Cellulitis of the ear is a type of skin and skin structure infection
  • The drug should only be used to treat infections proven or strongly suspected to be caused by susceptible bacteria

From the Research

Cellulitis of the Ear

• Cellulitis is a common skin infection that can affect any part of the body, including the ear 3.
• The diagnosis of cellulitis is typically based on clinical presentation, including symptoms such as redness, warmth, swelling, and tenderness 3, 4.
• The majority of non-purulent, uncomplicated cases of cellulitis are caused by β-hemolytic streptococci or methicillin-sensitive Staphylococcus aureus 3.
• Antibiotic selection for cellulitis is determined by patient history and risk factors, severity of clinical presentation, and the most likely microbial culprit 4.
• For outpatients with cellulitis in areas with a high prevalence of community-associated methicillin-resistant Staphylococcus aureus (MRSA) infections, antibiotics with activity against community-associated MRSA, such as trimethoprim-sulfamethoxazole and clindamycin, are preferred empiric therapy 5.
• The route of antibiotic administration (intravenous or oral) does not appear to affect the outcome of treatment for cellulitis, and the duration of antibiotic therapy does not seem to be associated with the outcome 6.

Treatment Options

• Trimethoprim-sulfamethoxazole, cephalexin, and clindamycin are commonly prescribed antibiotics for cellulitis 5.
• Clindamycin may be preferred for patients with moderately severe cellulitis, obesity, or culture-confirmed MRSA infections 5.
• Penicillin, amoxicillin, and cephalexin may be sufficient for non-purulent, uncomplicated cases of cellulitis caused by β-hemolytic streptococci or methicillin-sensitive Staphylococcus aureus 3.

Diagnosis and Management

• Cellulitis can be difficult to diagnose due to the presence of infectious and non-infectious clinical mimickers 3, 4.
• A thorough history and clinical examination can help narrow the differential diagnosis and minimize unnecessary hospitalization 4.
• Microbiological diagnosis is often unobtainable due to poor sensitivity of culture specimens 3.
• The etiology of cellulitis is often unclear, and treatment with broad-spectrum antibiotics is common 7.